American Journal of Occupational Therapy

OBJECTIVE. Pediatric constraint-induced movement therapy (CIMT) is a promising intervention for children with unilateral cerebral palsy (CP). This multisite randomized controlled trial (RCT) tested the hypothesis that 6 hr versus 3 hr per day for 21 days would produce larger maintenance of gains 6 mo posttreatment.

METHOD. Three sites recruited 18 children (6 per site) ages 3–6 yr with unilateral CP. Children were randomly assigned to 3 or 6 hr/day of CIMT for 21 days and wore a cast on the unaffected extremity the first 18 days. Occupational therapists applied a standardized pediatric CIMT protocol. Evaluators blinded to condition administered the Assisted Hand Assessment and the Quality of Upper Extremity Skills Test, and parents completed the Pediatric Motor Activity Log pre- and posttreatment (1 wk, 1 mo, and 6 mo).

RESULTS. Both CIMT dosage groups showed significant gains on all five assessments with no significant group differences at 6-mo follow-up. Effect sizes (n = 15) comparing preintervention to postintervention measures (partial η²) ranged from .33 to .80.

CONCLUSION. This first multisite RCT of pediatric CIMT confirmed the maintenance of positive effects at 6 mo follow-up across multiple functional performance measures. The hypothesis that maintenance of effects would differ for children who received 6 versus 3 hr/day of CIMT (126 vs. 63 total hr) was not supported.

OBJECTIVE. This study evaluated the effectiveness of neurocognitive habilitation, a group therapy intervention for foster and adoptive caregivers and their children who were prenatally exposed to alcohol.

METHOD. Participants were recruited from clients seeking evaluation for fetal alcohol syndrome (FAS) and alcohol-related neurodevelopmental disorder (ARND) and were randomly assigned to treatment and no-treatment control groups. Forty children participated in the treatment program and were compared with 38 control participants using the Behavior Rating Inventory of Executive Function (BRIEF) and the Roberts Apperception Test for Children (RATC).

RESULTS. Significant differences between the treatment and control groups were demonstrated on the BRIEF and on the RATC, suggesting that the intervention improved executive functioning and emotional problem-solving skills.

CONCLUSION. These findings yield promising evidence of the effectiveness of the neurocognitive habilitation intervention in improving executive functioning and emotional problem solving in children with FAS or ARND.

OBJECTIVE. We determined (1) whether active range of motion (AROM) of shoulder flexion and wrist extension measured at the initial therapy evaluation in the acute hospital predicted upper-extremity (UE) motor function 3 mo after stroke and (2) whether the presence of nonmotor impairments influenced this prediction.

METHOD. We collected AROM data from 50 people with stroke during their initial acute hospital therapy evaluation and UE motor function data 3 mo later. Multiple regression techniques determined the predictive ability of initial AROM on later UE motor function.

RESULTS. Initial AROM explained 28% of the variance in UE motor function 3 mo poststroke. Nonmotor deficits did not contribute to the variance.

CONCLUSION. Compared with later AROM measurements, initial values did not adequately predict UE motor function 3 mo after stroke. Clinicians should use caution when informing clients of UE functional prognosis in the early days after stroke.

OBJECTIVE. The goal for this study was to determine methods to modify outcome measures for people with aphasia and to provide beginning support for the efficacy of these suggested modifications.

METHOD. Twenty-nine community-dwelling people with aphasia participated. Modified outcome measures included the Stroke Impact Scale, the 36-item short form Medical Outcomes Study, Reintegration to Normal Living Scale, and Activity Card Sort. Participants were supported in their responses by systematically applying a hierarchy of support. An Independence Scale score was determined for each measure for each participant.

RESULTS. Data from an examiner-rated Independence Scale, internal consistency of participants’ responses, correlations among subscale scores across measures, and correlations between aphasia severity and reported outcome provide evidence that people with aphasia are able to understand and respond with these supports.

CONCLUSION. We provide key recommendations for making self-report measures accessible for people with aphasia.

OBJECTIVE. We examined the use of robotics to treat upper-extremity (UE) dysfunction in tetraplegic patients with spinal cord injury (SCI).

METHOD. A 51-yr-old man with an incomplete SCI participated in an occupational therapy program that combined traditional occupational therapy with Reo Go^®, a comprehensive therapy platform that includes a robotic guide featuring a telescopic arm to enable high repetitions of functionally relevant UE exercises.

RESULTS. The participant demonstrated measurable improvements in active range of motion, muscle strength as measured through manual muscle testing, perceived right UE function, and self-care performance as measured by the FIM™.

CONCLUSION. The findings from this case are promising and demonstrate the Reo Go’s utility in combination with traditional occupational therapy. However, more research and specific protocols that are easily reproducible with robots such as the Reo Go are needed to validate this evolving treatment area.

OBJECTIVE. We examined the effects of sensory-enhanced hatha yoga on symptoms of combat stress in deployed military personnel, compared their anxiety and sensory processing with that of stateside civilians, and identified any correlations between the State–Trait Anxiety Inventory scales and the Adolescent/Adult Sensory Profile quadrants.

METHOD. Seventy military personnel who were deployed to Iraq participated in a randomized controlled trial. Thirty-five received 3 wk (≥9 sessions) of sensory-enhanced hatha yoga, and 35 did not receive any form of yoga.

RESULTS. Sensory-enhanced hatha yoga was effective in reducing state and trait anxiety, despite normal pretest scores. Treatment participants showed significantly greater improvement than control participants on 16 of 18 mental health and quality-of-life factors. We found positive correlations between all test measures except sensory seeking. Sensory seeking was negatively correlated with all measures except low registration, which was insignificant.

CONCLUSION. The results support using sensory-enhanced hatha yoga for proactive combat stress management.

We used the Safe Driving Behavior Measure (SDBM) to determine rater reliability and rater effects (erratic responses, severity, leniency) in three rater groups: 80 older drivers (mean age = 73.26, standard deviation = 5.30), 80 family members or caregivers (age range = 20–85 yr), and two driving evaluators. Rater agreement was significant only between the evaluators and the family members or caregivers. Participants rated driving ability without erratic effects. We observed an overall rater effect only between the evaluator and family members or caregivers, with the evaluators being the more severe rater group. Training family members or caregivers to rate driving behaviors more consistently with the evaluator’s ratings may enhance the SDBM’s usability and provide a role for occupational therapists to interpret proxy reports as an entry point for logical and efficient driving safety interventions.

We used a grounded theory approach to data analysis to discover what effect, if any, children’s sensory experiences have on family occupations. We chose this approach because the existing literature does not provide a theory to account for the effect of children’s sensory experiences on family occupations. Parents of six children who were typically developing and six children who had autism were interviewed. We analyzed the data using open, axial, and selective coding techniques. Children’s sensory experiences affect family occupations in three ways: (1) what a family chooses to do or not do; (2) how the family prepares; and (3) the extent to which experiences, meaning, and feelings are shared.

OBJECTIVE. Clinical reasoning studies have acknowledged tacit aspects of practice, and recent research suggests that clinical reasoning contains intuition informed by tacit knowledge. Intuition also appears to be influenced by awareness and understanding of emotions. This study investigated the relationship between intuition and emotional intelligence among occupational therapists in mental health practice.

METHOD. We mailed a survey containing measures of cognitive style and of use of emotional competencies at work and demographic questions to 400 members of the national occupational therapy association; 134 occupational therapists responded.

RESULTS. A moderate relationship was found between intuitive cognitive style and emotional intelligence. Experienced therapists scored higher on the use of emotional competencies at work and reported a preference for an intuitive cognitive style to a greater extent than novices.

CONCLUSION. This study represents the first attempt to explore occupational therapists’ preferred cognitive style and self-reported emotional intelligence. Findings suggest that exploring emotions through reflective practice could enhance intuitive aspects of clinical reasoning.

We investigated interrater reliability of range of motion (ROM) measurement in the finger joints of people with Dupuytren’s disease. Eight raters measured flexion and extension of the three finger joints in one affected finger of each of 13 people with different levels of severity of Dupuytren’s disease, giving 104 measures of joints and motions. Reliability measures, represented by intraclass correlation coefficient (ICC), standard error of the mean (SEM), and differences between raters with the highest and lowest mean scores, were calculated. ICCs ranged from .832 to .973 depending on joint and motion. The SEM was ≤3° for all joints and motions. Differences in mean between highest and lowest raters were larger for flexion than for extension; the largest difference was in the distal interphalangeal joint. The results indicate that following these standardized guidelines, the interrater reliability of goniometer measurements is high for digital ROM in people with Dupuytren’s disease.

OBJECTIVE. The authors compared changes in client performance on three goals poststroke after the Cognitive Orientation to daily Occupational Performance (CO–OP) intervention or standard occupational therapy (SOT) to determine the magnitude and direction of change.

METHOD. Eight people living in the community following a stroke were randomly assigned to receive CO–OP (n = 4) or SOT (n = 4). CO–OP is a 10-session, cognitive-oriented approach to improving performance that uses client-driven cognitive strategies. SOT was therapist driven and combined task-specific and component-based training. Goal performance was measured by the therapist-rated Performance Quality Rating Scale (PQRS) and the participant-rated Canadian Occupational Performance Measure (COPM).

RESULTS. Using Mann-Whitney U test, we found that CO–OP participants showed significantly greater improvement in performance (PQRS, p = .02; COPM Performance, p = .02) compared with SOT but no improvement in satisfaction (COPM Satisfaction, p = .38).

CONCLUSION. The CO–OP group demonstrated larger performance improvements than the SOT group. Because of the promising results, an investigation using a larger sample is warranted.

The use of driving simulators is increasing in clinical settings that provide driving evaluation and rehabilitation. To identify the driving simulator scenarios desired by certified driver rehabilitation specialists (CDRSs), we developed a questionnaire consisting of 22 driving scenario situations. A total of 164 CDRSs rated each situation in terms of its importance for inclusion in simulator-based driving. The four situations they identified as most critical were turning left across oncoming traffic, navigating four-way intersections with traffic lights or signs, driving in multiple lanes with traffic on both sides, and reacting to unexpected events that require emergency braking or aggressive maneuvers to prevent an accident. We conducted exploratory and confirmatory factor analyses to group the 22 driving scenario situations. The model with the best fit included 11 situations forming three factors: (1) Intersections, (2) Roadway and Traffic Conditions, and (3) Environmental Conditions. Future studies should include these factors in driving simulator scenarios and evaluate their clinical efficacy in driving evaluation and rehabilitation.

OBJECTIVE. The Health Promoting Activities Scale (HPAS) measures the frequency with which mothers participate in self-selected leisure activities that promote health and well-being. We undertook an initial evaluation of the scale with mothers of school-age children with developmental disabilities (N = 152).

METHOD. We used a mixed methodology in the instrument design: a qualitative study to generate items and a quantitative study to evaluate the instrument. Our statistical analysis assessed the internal consistency, factor structure, and construct validity of the HPAS.

RESULTS. The HPAS showed good internal consistency (Cronbach’s α = .78). Construct validity was supported by moderate correlations with subjective maternal mental and general health (Short Form 36, Version 2) and by differentiation in leisure participation among groups of mothers reporting differences in mental health status.

CONCLUSION. Initial evaluation of the HPAS indicates that this brief tool is psychometrically sound. The HPAS allows professionals to evaluate clients’ participation in leisure occupations that promote health and well-being. Further development of the HPAS is warranted.

This qualitative research study examined the experiences of practitioners who developed and implemented driving rehabilitation programs within the past 5 yr. Researchers interviewed 4 occupational therapists with 10–19 yr of experience, who identified the following facilitators of and barriers to driving program implementation: funding and equipment, institutional support, interdisciplinary conflict, role expectations, professional development, and staffing. Results support prior quantitative research identifying barriers to developing and sustaining driving and community mobility programs. Findings also suggest that program success is dependent on much more than clinical expertise. Results provide occupational therapists with a foundation of expectations when developing new programs to assist them with anticipating and counteracting barriers to success.